Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!


One of the main purposes of the preoperative history and physical exam is to identify any preoperative medical comorbidity that may lead to an increased perioperative morbidity or mortality. If comorbidities are identified, the surgeon should obtain medical consultation to ensure that the patient’s medical conditions are optimized and stable enough to proceed with surgery at an acceptable risk.


Clinical Findings

Most gynecologic surgeries fall in the category of low (< 1%) or intermediate (1–5%) risk of cardiac death or nonfatal myocardial infarction (Table 47–1). It is crucial to obtain a careful preoperative history to discover cardiac and/or comorbid diseases that would place the patient in a high surgical risk category. If the patient is found to have active cardiac conditions, such as unstable coronary syndrome, decompensated heart failure, significant arrhythmias, or severe valvular disease, the surgery should be delayed or cancelled (unless emergent), and the patient should be evaluated and treated (Table 47–2).

Table 47–1.Cardiac risk (cardiac death and nonfatal myocardial infarction) for noncardiac procedures.
Table 47–2.Clinical risk factors for increased perioperative cardiovascular complications (myocardial infarction, heart failure, death).

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.